The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Nov 1996
Randomized Controlled Trial Multicenter Study Clinical TrialPrimary anterior dislocation of the shoulder in young patients. A ten-year prospective study.
Two hundred and forty-five patients who had had 247 primary anterior dislocations of the shoulder were followed for ten years in a multicenter study at twenty-seven Swedish hospitals. The ages of the patients at the time of the dislocation ranged from twelve to forty years. The patients were assigned to one of three treatment groups: immobilization with the arm tied with a bandage to the torso for three to four weeks after reduction of the dislocation; use of a sling, which was discontinued after the patient was comfortable; or immobilization for various durations. ⋯ Radiographs made for 208 shoulders at the ten-year follow-up examination were evaluated for post-dislocation arthropathy. Twenty-three shoulders (11 per cent) had mild arthropathy and eighteen (9 per cent) had moderate or severe arthropathy. Some of the shoulders that had arthropathy had had no recurrence.
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J Bone Joint Surg Am · Nov 1996
Randomized Controlled Trial Clinical TrialEfficacy of injections of corticosteroids for subacromial impingement syndrome.
A prospective, randomized, controlled, double-blind clinical study was performed to determine the short-term efficacy of subacromial injection of corticosteroids for the treatment of subacromial impingement syndrome. Forty patients were randomized to receive either six milliliters of 1 per cent lidocaine without epinephrine (the control group) or two milliliters containing forty milligrams of triamcinolone acetonide per milliliter with four milliliters of 1 per cent lidocaine without epinephrine (the corticosteroid group). The patients were re-examined serially until completion of the study. ⋯ The mean active range of forward elevation and external rotation improved by 24 and 11 degrees, respectively, for the corticosteroid group and by 10 and 5 degrees, respectively, for the control group. We concluded that subacromial injection of corticosteroids is an effective short-term therapy for the treatment of symptomatic subacromial impingement syndrome. The use of such injections can substantially decrease pain and increase the range of motion of the shoulder.
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J Bone Joint Surg Am · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialOperative treatment of fractures of the tibial plafond. A randomized, prospective study.
We performed a randomized, prospective study to compare the results of two methods for the operative fixation of fractures of the tibial plafond. Surgeons were assigned to a group on the basis of the operation that they preferred (randomized-surgeon design). In the first group, which consisted of eighteen patients, open reduction and internal fixation of both the tibia and the fibula was performed through two separate incisions. ⋯ All of the patients, in both groups, who had had a type-II or III fracture had some degree of osteoarthrosis on plain radiographs at the time of the latest follow-up. With the numbers available, there was no significant difference between the two groups with regard to the osteoarthrotic changes. We concluded that external fixation is a satisfactory method of treatment for fractures of the tibial plafond and is associated with fewer complications than internal fixation.
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Varicella, commonly known as chickenpox, is a common viral infection in children. An estimated 3.5 million cases occur annually in the United States. Serious musculoskeletal complications such as osteomyelitis and necrotizing fasciitis, although uncommon, can be life and limb-threatening. ⋯ Group-A beta-hemolytic streptococcus was also the causative organism in two of the four patients who had septic arthritis, three of the five who had necrotizing fasciitis, and all ten who had a deep-tissue abscess. Nine of the eleven musculoskeletal complications leading to operative treatment in 1994 had group-A beta-hemolytic streptococcus as the causative organism. An understanding of the trends of and a high level of suspicion for potentially serious secondary infections in children who have varicella is necessary for prompt recognition and appropriate treatment.
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J Bone Joint Surg Am · Nov 1996
Results of arthrodesis of the tarsometatarsal joints after traumatic injury.
We retrospectively reviewed the records of thirty-two patients who had had an arthrodesis of the tarsometatarsal joints for intractable pain after a traumatic injury of the midfoot. The arthrodesis was performed at a mean of thirty-five months (range, six to 108 months) after the injury. All of the procedures were performed with use of rigid internal fixation, and twenty-four patients, in whom a defect had been created by debridement of the joints, were managed with an autogenous bone graft. ⋯ The evaluation included a physical examination, radiographs, and use of the rating scale of the American Orthopaedic Foot and Ankle Society for the evaluation of the midfoot. The mean postoperative score of 78 (of a possible 100) points was significantly better than the mean preoperative score of 44 points (p = 0.02). With the numbers available, we could not show that the extent of the arthrodesis, the involvement of other joints in the hindfoot or the forefoot, the mechanism of injury, or whether the injury was work-related significantly affected the functional outcome.